Normal Labor and Delivery Nursing Care

Signs and Symptoms of the Stage 1 -- Latent Phase Contraction: dilate 0-3 cm. Mild Duration – 30-45 seconds Frequency – 5-20 minutes Scant pinkish discharge, bloody show Mother’s response Surge of energy and excited Talkative, outgoing Anxiety low **Best time to do teaching!

Nursing Care Stage 1 – Latent Phase Welcome to the Hospital Assess goals for this labor Assess Psychological response Orient to common procedures Vital signs and FHT’s Enema IV NPO Assessment of Labor Progress – dilation, effacement, station, lie, etc.

Stage 1 – Active Phase Signs and Symptoms Contractions – dilate 4-7 cm. Moderate Duration – 45-60 seconds Frequency – 2-5 minutes Mother’s Response More serious Determined, Dependent Restless Focuses on self

Stage 1 – Active Phase Nursing Care Anticipate Needs: Sponge face with cool cloth Keep bed clean and dry- change chux Provide with mouth care – lip balm to lips Assess voiding Non-Pharmacological Measures Modified breathing Effleurage Music Analgesia and Anesthesia

Stage 1 – Transition Phase Signs and Symptoms Contractions 7-10 cm Strong Irregular with multiple peaks Duration – 60-90 seconds Frequency – 2 minutes Mother’s response Withdrawn, drowsy, Nausea, trembling of legs Irritable, aggressive Urge to push

Stage 1- Transition Nursing Care Provide support- may need to breathe with the patient – get in her face Back rub Assist with pant-blow breathing Watch for hypervention – have breathe in mask and slow down the breathing Do NOT allow to push by having patient blow-blow-blow with urge. Do not be offended by irritability

Stage Two of Labor Signs and Symptoms: Sudden Appearance of sweat on upper lip An episode of vomiting Increase in bloody show Shaking of extremities Increased restlessness Pressure on rectum; involuntary bearing down Bulging of perineum

Stage 2 Nursing Care The key to care during this stage is to teach QUALITY PUSHING ! Keep perineum clean and dry Provide quiet environment Support with positive feedback Repeat doctors instructions Allow to hold the baby , Congratulate!!

Stage 2 – Mechanisms of Labor 1. Engagement and Descent 2. Flexion 3. Internal Rotation 4. Extension 5. External Rotation 6. Expulsion

Stage 3 of Labor Signs and Symptoms of Placental Separation: 1. A globular rise in the abdomen the placenta changes from a discoid to a globular shape 2. Sudden gush of blood 3.Lengthening of the cord

Stage 3 – Nursing Care Congratulate on delivery of baby Coach in relaxation for delivery of the placenta Initiate contact with the infant May allow to breast feed if desires

Test Yourself! The cardinal movement that facilitates the emergence of the fetal head ____________. A. Flexion B. Extention C. External rotation Cardinal movement that allows the smallest diameter of the head to pass through the pelvis is__________________. B. Internal rotation C. Extension Cardinal movement that occurs as the fetal shoulders engage and descend through the pelvis is termed ______. A. Internal rotation B. External rotation

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Causes of Pain in Labor Stage One Stretching of the cervix during dilation & effacement Stage One Uterine Anoxia Stretching of the uterine ligaments

Causes of Pain in Labor Stage Two Distention of the vagina and Perineum Compression of the nerve ganglia in cervix & lower uterus Stage Two Pressure on urethra, bladder, rectum during fetal descent Traction on and stretching of the perineum

Factors affecting Mothers Response to Pain in Labor Knowledge and confidence gained through childbirth classes Cultural influences on expression of pain Maternal fatigue and anxiety Previous experiences with pain

Methods of Pain Relief Nonpharmacologic Childbirth methods Effleurage Breathing Techniques Relaxation Techniques Touch Focusing attention on one object Effleurage

Non-Pharmacological Sensory Stimulation Listening to music; subdued lighting Imagery Applying heat and cold Massage (lower back); Counterpressure TENS Position Changes

Pain Relief in Labor Pharmacologic Methods Analgesia Barbiturates Demerol Stadol Barbiturates Seconal; Nembutal Tranquilizers Vistaril

Anesthesia Regional Local General Paracervical Epidural; Caudal Spinal Pudendal Local General Used mainly in cesarean deliveries

True or False ? The anesthesia used for both labor and delivery is an epidural A. True B. False The anesthesia used for delivery and an episiotomy is paracervical.

True or False ? The nurse would be careful to keep the patient flat following delivery with a pudendal block A. True B. False The initial side effect of an epidural anesthesia is fetal bradycardia

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